Prime Healthcare

Utilization Review Coordinator

Facility Prime Healthcare Management Inc
Business Professional
Position Type
Full Time


Coordinates and reviews all medical records, as assigned to caseload. Actively participates in Case Management and Treatment Team meetings. Serves as on-going educator to all departments. Responsible for reviewing patient charts in order to assess whether the criteria for admission and continuation of treatment is being met; gathering data and responding to request for records from fiscal intermediary; gathering clinical and fiscal information and communicating status of both open and closed accounts for multiple levels of Utilization Review and Case Management reporting. Able to work independently and use sound judgment. Knowledge of Federal, State, and intermediary guidelines related to inpatient, acute care hospitalization, as well as lower levels of care for the continuity of treatment. Coordinates discharge referrals as requested by clinical staff, fiscal intermediary, patients, and families. Performs other duties as assigned.




Education and Work Experience

  1. Medical Graduate, PA, or Nursing Graduate required.
  2. ECFMG Certification / Bachelor's or higher from a US-based accredited institution in a Health and Human Services field is highly preferred.
  3. Utilization Review experience preferred.
  4. Must meet the performance standards set forth by the Hospital/ Department at UR Coordinator I position for at least 6 months.
  5. In order to be promoted to UR Coordinator II position; the Employee must meet certain performance standards as defined by the Hospital/Department.
  6. In order to be promoted to Corporate Case Manager position; the Employee must meet certain performance standards as defined by the Hospital/ Department and obtain the Certified Case Manager credential. 1+ year of utilization review experience is highly preferred.
  7. 1+ year of clinical experience in acute care setting preferred.
  8. 1+ year of experience with ICD-10 and CPT coding in an acute care setting preferred.
  9. Experience with use of an encoder software product for code assignment in an acute care setting preferred.
  10. Excellent written and verbal communication skills. Excellent critical thinking skills.
  11. Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff, coding staff and hospital management staff.
  12. Ability to work independently in a time-oriented environment.
  13. Computer literacy and familiarity with the operation of basic office equipment.
  14. Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm preferred

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources. EEO is the Law:


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